Widow Spider Envenomation
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Widow spiders belong to the genus Latrodectus and include the black widow spider (Latrodectus mactans mactans) in the United States. The term widow spider is used because not all species in the genus Latrodectus are black. Other widow spiders in North America include the brown widow (Latrodectus geometricus), the red-legged widow (Latrodectus bishopi), Latrodectus variolus, and Latrodectus hesperus. The redback spider (Latrodectus hasselti) is endemic to Australia. Latrodectus mactans tredecimguttatus and Latrodectus pallidus are found in Europe and South America, and the button spider (Latrodectus indistinctus) is found in South Africa.
The adult female black widow spider is approximately 2 cm in length and shiny black with a red-orange hourglass or spot on the ventral abdomen. The male is much smaller, brown, and incapable of envenomating humans. Juvenile females are also brown but have the general body morphology of the adult. Males and juveniles have a pale hourglass shape, similar to adult females. The female sometimes eats the male during or after copulation. Webs are irregular, low-lying, and commonly seen in garages, barns, outhouses, and foliage. Other widow spiders are generally black but may have red spots, such as Latrodectus mactans tredecimguttatus, or a dorsal red stripe, such as the redback spider. Latrodectus geometricus is brown with red and yellow markings.
See the images below.
Envenomation is an uncommon occurrence with an extremely variable presentation. Treatment of envenomation often is based on speculation and anecdote, and much of the literature is contradictory. This article attempts to keep recommendations in agreement with the most current standards of care. This article serves as a guideline, and the clinician should use judgment for individual patient encounters.
See Arthropod Envenomation: From Benign Bites to Serious Stings and Venomous Spider Bites: Keys to Diagnosis and Treatment, Critical Images slideshows, for help identifying and treating various envenomations.
Alpha-latrotoxin causes the toxic effects observed in humans by opening cation channels (including calcium channels) presynaptically, causing increased release of multiple neurotransmitters. This results in excess stimulation of motor endplates with resultant clinical manifestations. Clinically, the predominant effects are neurological and autonomic, in contrast to the dermonecrotic local effects associated with spiders causing necrotic arachnidism (eg, brown spiders [Loxosceles species]).
According to the 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS), approximately 1300 widow spider bites were reported for 2016, [1] although this figure is probably conservative because of underreporting. No deaths caused by widow spider envenomation have been reported to the AAPCC since its first annual report in 1983. [1] Deaths after black widow spider bites were reported in 2001, [2] 2003, [3] and 2006 in Spain, Greece, and Albania (2 deaths), respectively. [4]
The vast majority of patients with widow spider envenomations recover fully.
For patient education resources, see the Bites and Stings Center, as well as Black Widow Spider Bite and Brown Recluse Spider Bite.
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila). 2017 Dec. 55 (10):1072-1252. [Medline]. [Full Text].
Gonzalez Valverde FM, Gomez Ramos MJ, Menarguez Pina F, Vazquez Rojas JL. [Fatal latrodectism in an elderly man]. Med Clin (Barc). 2001 Sep 22. 117(8):319. [Medline].
Pneumatikos IA, Galiatsou E, Goe D, Kitsakos A, Nakos G, Vougiouklakis TG. Acute fatal toxic myocarditis after black widow spider envenomation. Ann Emerg Med. 2003 Jan. 41(1):158. [Medline].
Hoxha R. Two Albanians die from black widow spider bites. BMJ. 2006 Aug 5. 333(7562):278. [Medline]. [Full Text].
Bush SP, Thomas TL, Chin ES. Envenomations in children. Pediatr Emerg Med Rep. 1997. 2:1-12.
Woestman R, Perkin R, Van Stralen D. The black widow: is she deadly to children?. Pediatr Emerg Care. 1996 Oct. 12(5):360-4. [Medline].
Cohen J, Bush S. Case report: compartment syndrome after a suspected black widow spider bite. Ann Emerg Med. 2005 Apr. 45(4):414-6. [Medline].
Bush SP. Black widow spider envenomation mimicking cholecystitis. Am J Emerg Med. 1999 May. 17(3):315. [Medline].
Allen RC, Norris RL. Delayed use of widow spider antivenin. Ann Emerg Med. 1995 Sep. 26(3):393-4. [Medline].
Clark RF. The safety and efficacy of antivenin Latrodectus mactans. J Toxicol Clin Toxicol. 2001. 39 (2):125-7. [Medline].
Murphy CM, Hong JJ, Beuhler MC. Anaphylaxis with Latrodectus antivenin resulting in cardiac arrest. J Med Toxicol. 2011 Dec. 7 (4):317-21. [Medline]. [Full Text].
Isbister GK, Page CB, Buckley NA, Fatovich DM, Pascu O, MacDonald SP, et al. Randomized controlled trial of intravenous antivenom versus placebo for latrodectism: the second Redback Antivenom Evaluation (RAVE-II) study. Ann Emerg Med. 2014 Dec. 64 (6):620-8.e2. [Medline].
Dart RC, Bogdan G, Heard K, Bucher Bartelson B, Garcia-Ubbelohde W, Bush S, et al. A randomized, double-blind, placebo-controlled trial of a highly purified equine F(ab)2 antibody black widow spider antivenom. Ann Emerg Med. 2013 Apr. 61 (4):458-67. [Medline].
Dart, RC, Heard, K, Bush, SP et al. A Phase III Clinical Trial of Analatro [Antivenin Latrodectus (Black Widow) Equine Immune F 9ab’)2] in Patients with Systemic Latrodectism. Accepted to Clin Tox (will be presented as abstract at 2016 NACCT).
Boyer LV, Binford GJ, Degan JA. Spider Bites. Auerbach PS, ed. Wilderness Medicine. 6th ed. St. Louis, Mo: Mosby; 2011. 975-95.
Bush SP, Naftel J. Injection of a whole black widow spider. Ann Emerg Med. 1996 Apr. 27(4):532-3. [Medline].
Sean P Bush, MD, FACEP Professor of Emergency Medicine, The Brody School of Medicine at East Carolina University
Sean P Bush, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, International Society on Toxicology, Society for Academic Emergency Medicine, Wilderness Medical Society
Disclosure: Nothing to disclose.
Jennifer P Cohen, MD Emergency Physician, Mt Graham Regional Medical Center; Medical Toxicologist, Arizona Poison and Drug Information Center
Disclosure: Nothing to disclose.
John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph’s Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.
James Steven Walker, DO, MS Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association
Disclosure: Nothing to disclose.
Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center
Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.
Robert L Norris, MD Professor Emeritus, Department of Emergency Medicine, Stanford University Medical Center
Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, Wilderness Medical Society
Disclosure: Nothing to disclose.
Widow Spider Envenomation
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